title: Ocular complications after posterior superior alveolar nerve block: a case of trochlear nerve palsy.
abstract: Many intraoperative complications occurring during third molar surgery are described in the literature. Unilateral trochlear nerve palsy secondary to dental anaesthesia is a rare complication. We report the case of a 36-year-old healthy man, ASA I classification, requiring upper third molar extraction. Articaine 1:200,000 epinephrine for right posterior superior alveolar (PSA) nerve block was administered locally in the mucobuccal fold above the upper third molar. A few minutes after PSA nerve block the patient experienced double-vision. The patient was subsequently visited by an ophthalmologist and the condition was diagnosed as transient unilateral vertical diplopia due to temporary paralysis of the superior oblique muscle as a result of the anaesthetic solution involving the IV cranial nerve. The authors report this unusual case and discuss the possible anatomical pathways that might explain this rare phenomenon.
authors.affiliation: Tuscan School of Dental Medicine, University of Siena, Siena, Italy. Electronic address: goez@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Chisci
authors.forename: C
authors.initials: C
authors.lastname: Chisci
authors.forename: V
authors.initials: V
authors.lastname: Chisci
authors.forename: E
authors.initials: E
authors.lastname: Chisci
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000772:Anesthesia, Local / Q000009:adverse effects*; D002355:Carticaine / Q000008:administration & dosage* / Q000009:adverse effects; D004172:Diplopia / Q000209:etiology*; D006801:Humans; D008297:Male; D008442:Maxillary Nerve; D008964:Molar, Third / Q000601:surgery*; D009407:Nerve Block / Q000009:adverse effects*; D009801:Oculomotor Muscles / Q000473:pathology; D020432:Trochlear Nerve Diseases / Q000209:etiology*
chemical_list: D002355:Carticaine
keywords: anaesthetic injection; diplopia; local anaesthesia; ocular complications; ophthalmologic complications; palsy; posterior superior alveolar nerve; third molar; trochlear nerve